Ejaculation Problems - NHS

Premature ejaculation

Premature ejaculation is a common ejaculation problem. It's where the male ejaculates sooner than he or his partner wishes during sexual arousal.

Occasional episodes of premature ejaculation are common and are not a cause for concern. However, if you're finding that it happens more than you'd like, and it's a problem for you, it might help to get treatment.

Causes of premature ejaculation 

Various psychological and physical factors can cause a man to suddenly experience premature ejaculation.

Common physical causes include:

• prostate problems
• thyroid problems – an overactive thyroid or an underactive thyroid
• using recreational drugs

Common psychological causes may include:

• depression
• stress
• relationship problems
• anxiety about sexual performance (particularly at the start of a new relationship, or when a man has had previous problems with sexual performance)

It's possible for a man to have experienced premature ejaculation since becoming sexually active. A number of possible causes for this are:

• conditioning – it's possible that early sexual experiences can influence future sexual behaviour. For example, if a teenager conditions himself to ejaculate quickly to avoid being caught masturbating, it may later be difficult to break the habit
• a previous traumatic sexual experience – this can range from being caught masturbating to sexual abuse
• a strict upbringing and beliefs about sex

Treating premature ejaculation

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant, but they also delay ejaculation. SSRIs used for this purpose include:

• paroxetine
• sertraline
• fluoxetine (Prozac)

Another type of antidepressant called clomipramine is also sometimes used.

Some men may experience an improvement a few days after treatment begins. However, you'll usually need to take the medicine for 1 to 2 weeks before you notice the full effects.

Side effects of SSRIs are usually mild and should improve after 2 to 3 weeks. They include:

• feeling sick and being sick
• diarrhoea
• excessive sweating (hyperhidrosis)

Read more about the side effects of antidepressants.

Dapoxetine (Priligy)

An SSRI specifically designed to treat premature ejaculation, known as dapoxetine (Priligy), has been licensed in the UK. Local NHS authorities can choose to prescribe it on the NHS.

It acts much faster than the other SSRIs used for premature ejaculation and can be used "on demand". You'll usually be advised to take it between 1 and 3 hours before sex, but not more than once a day.

Your response to the treatment will then be reviewed after 4 weeks (or after 6 doses), and again every 6 months.

Dapoxetine is not suitable for all men diagnosed with premature ejaculation. For example, it is not recommended for some men with heart, kidney and liver problems. It can also interact with other medicines, such as other antidepressants.

Common side effects include:

• headaches
• dizziness
• feeling sick

Phosphodiesterase-5 inhibitors

Phosphodiesterase-5 inhibitors, such as sildenafil (sold as Viagra), are a class of medicine used to treat erectile dysfunction. Research has found that they may also help with premature ejaculation.

You can get sildenafil on prescription, or buy it from a pharmacy after a discussion with the pharmacist to make sure it's safe for you to take.

Read more about sildenafil including information on how and when to take it.

Topical anaesthetics and condoms

The use of topical anaesthetics such as lidocaine or prilocaine can help but may be transferred and absorbed to the vagina, causing decreased sensation. Condoms can also be used and are effective, particularly when combined with local anaesthesia.

Things you can try yourself

There are also a number of things you can try yourself. It can sometimes help to:

• masturbate an hour or 2 before having sex
• use a thick condom to help decrease sensation
• have sex with your partner on top (to allow them to pull away when you are close to ejaculating)

Psychosexual counselling

You may benefit from having psychosexual counselling, where a therapist can help you, and a partner if you have one, with sex related problems. During these sessions, the therapist will:

• encourage you to explore any relationship issues you may have, and give advice about how to resolve them
• show you techniques that can help you "unlearn" the habit of premature ejaculation (these include the "squeeze" and "stop-go" techniques)

In the squeeze technique, you masturbate but stop before the point of ejaculation and squeeze the head of your penis for between 10 to 20 seconds. Then let go and wait for another 30 seconds before resuming masturbation. This process is carried out several times before ejaculation is allowed to occur.

The stop-go technique is similar, but you do not squeeze your penis. Once you feel more confident about delaying ejaculation, you could try this technique during sex, stopping and starting as required.

These techniques may sound simple, but they require lots of practice.